Normally, fluid by limiting what and how

Normally, the waste product from the blood is
filtered through the kidneys, but when it over accumulates, it may produce
kidney stones. Kidney Stones are small, solid pebbles that are made of minerals
and salts that form within your kidneys, and it may become painful. There could
many reasons for the formation of kidney stones because it implicates
environmental and metabolic risk factors. Kidney stones mostly happen to
adults, but children and teenagers can get them, too. There are several treatments; how to treat it
will depend on the type, the size and the location of the stones either in the
kidneys or the urinary tract.

Kidney stones affect about 5% of the world
population. The peak age for kidney stones is between 20 years old and 50 years
old. Furthermore, the probability of having it is more in men than in women
(Figure 1). Family history may also increase the risk of getting kidney stones.
(University of Wisconsin Hospitals and Clinics Authority, 2013)

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Kidney stones occur in the urinary system. The
urinary system is made of different organs, such as the kidney, ureters,
urinary bladder, and urethra. The urinary system aids the body to get rid of
waste, like urea. It also keeps chemicals, such as potassium and sodium, and
water in check.

The excretory system is conformed of other
different systems: urinary system, respiratory system, biliary system, and
integumentary system. The main job of the excretory system is to eliminate all
waste the body produces that would otherwise interfere with cellular function;
it also regulates the content of the body’s fluid by limiting what and how much
can go out. In other words, the body seeks to be in homeostasis to prevent any
damage. To make it simple, without the mechanisms that allow the human system
to eliminate wastes, humans would die of intoxication, as is the case when the
kidneys or the liver stop working. A clear example of the excretory in action
is when cellular respiration produces carbon dioxide and it is removed from our
system by an effective circulatory system and respiratory system, which are
part of the excretory system.

There are several organs and structures that are
involved in the excretory system: kidneys, ureter, urinary bladder, urethra,
lungs, skin, some glands, etc. But the ones affected by kidney stones are only
in the urinary system: kidneys, ureter, bladder, prostate, urethra. “The
kidneys are two bean-shaped organs, which are about the size of a fist” (NIDDK,
2014). Arguably, the kidneys are the most important organs of this system. They
do three essential things that help to balance the body: purifying the blood
(table 1.1), regulating blood pressure and the amount of water in the body, and
synthesizing hormones, like erythropoietin which controls red blood cell
production. Once the kidneys have separated all waste, the urine goes from the
kidneys to the bladder through the ureter which are muscular tubes that are
about 28 centimetres long. Next, urine ends up in the bladder where it is
stored allowing it to be occasional. Finally, the urethra, the tube that
connects the bladder with the meatus, leads the final part of the urinary
system. The urine leaves the body through it.

Table 1

Normal
Blood Value Ranges in the body

Note. Reprinted from why are kidneys so important? The kidney Foundation
of Canada. Retrieved from https://www.kidney.ca/why-kidneys-are-important
Copyright 2017 by The Kidney Foundation of Canada

Kidneys are vey effective in eliminating waste
from the blood. Nevertheless, under certain circumstances, such as chronic
dehydration, some waste may accumulate in the kidney. As theses microscopic
crystals (waste) stick to each other, they become a larger and larger,
reaching, in some extreme cases, more than 10centimetres wide. For example,
according to the Guinness World Records (n.d) a kidney stone was removed, in
India, at the Urological research institute and it was 13 centimetres wide.

Certainly, there are different kind of kidney
stones. In other words, they can be made of different substances. There is
calcium, struvite, uric acid, and cystines stones. The most common ones are the
calcium stones, made mainly of calcium oxalate & calcium phosphate. About 80% of all stones are made of calcium
(Sakhaee, Maalou & Sinnott, 2012). There are several factors that could
produce these type of stone; for example, many foods have oxalate, such as nuts
and chocolate. High quantities of vitamin D may also contribute to calcium
stones. Struvite stones often form only due to an infection. The problem with
these stones is their fast grow rate and its often lack of symptoms. Uric acid
stones are normally present in people who don’t drink enough liquids and/or eat
food with high levels of proteins. Furthermore, there certain genetic factor
that may influence the formation of them. Lastly, cystine stones form
exclusively in people with certain hereditary issues that provoke the kidney to
make an excessive amount of specific amino acids that produce them.

Usually, a kidney stone doesn’t show any symptoms
until it is moving because it is formed of many microscopic crystals that may
cut tissue as it moves through the urinary system. The most common symptoms,
according to Mayo Clinic (2017), are:

·
Severe pain in the side and back, below the ribs

·
Pain that radiates to the lower abdomen and groin

·
Pain that comes in waves and fluctuates in
intensity

·
Pain on urination

·
Pink, red or brown urine

·
Cloudy or foul-smelling urine

·
Nausea and vomiting

·
Persistent need to urinate

·
Urinating more often than usual

·
Fever and chills if an infection is present

·
Urinating small amounts

This information brings a very interesting
question: where do kidney stones form? Kidney calcium stones usually form on
plaque, which is a deposit of calcium phosphate that forms within tissues, more
specifically in the Loops of Henle’s walls.

There are several factors that boost the
probabilities of having kidney stones: genetics, dehydration, obesity, certain
surgeries. First, family history of the disease increases the chances of having
it. Dehydration play an important role in kidney stone formation; people who
live in warm and humid environments tend to have more risk of it. There is a
correlation between obesity and kidney stones.

Although, symptoms can provide enough information
to set the basis, they cannot deliver enough data to discern what type of
stones is, until a full diagnosis have been done. Several diagnosis can be
made:

·
Ultrasound scan

·
Computed tomography

·
Blood test

·
Urine test

·
Analysis of passes stones

·
Medical history

Simple x-ray is not recommended because only
calcium stones are easy to identify. Struvite stones are harder to find, and
uric acid stones do not appear at all. With that being said, x-ray is useful to
figure out how favorable a treatment for calcium stones was.

Usually, small stones pass through the urinary
system, but when there are bigger stones, treatment is necessary. The kind of
treatment depends on several factors: size, composition, location of the stone,
as well as symptoms and medical history. There are invasive and non-invasive
treatments. The are many types of treatments from drinking plenty of fluids to Nephrolithotomy.
The most common treatments are: medication, shock wave therapy, ureteroscopy,
nephrolithotomy,
and nutritional therapy. When the stone is smaller than five millimetres, a
conservative management is used. This consists in a high fluid intake, as well
as a good and healthy diet, such as orange juice and oxalate restrictions.
According to Bogi, et al. (1996),
studies have shown that drinking 2.5 litres of water is related with reducing levels of Calcium oxalate. When
the stone is between five and ten millimetres or the stone has been stuck for
four week or more after observation, medication is required. Normally, these
are the most common medications: thiazide diuretic, potassium citrate,
allopurinol, and muscle-relaxing medications. Thiazide
diuretics and potassium citrate are used to reduce the excretion of calcium. Allopurinol
is used in patients who have uric acid stones. It reduces the levels of uric
acid. Muscle- relaxing medication, such as Tamsulosin, helps, as its name says,
with the relaxation of the muscle, making easier for the stones to pass trough.
This type of medication is for the most part used in patients whose stone is
the ureter. Finally, if the stone is bigger than ten millimetres or it has been
stuck even though medication has been given, surgery is required. There are
three main surgical options: Extracorporeal Shock Wave Lithotripsy, Ureteroscopy,
Percutaneous Nephrostolithotomy or Nephrolithotomy. ESWL, also known as shock
wave therapy, uses sound waves, thus creating vibrations, to shatter big
stones. This is the most used technique to treat kidney stones in the United
States (National Kidney Foundation, 2017). Percutaneous Nephrolithotomy: an
expert makes a small incision, about one centimetre, and a nephroscope is
inserted and the stones is removed. This is technique is used when the stone is
too big, in which case it has to first be broken up. Finally, when the stone is
in the ureter, it is commonly removed by ureteroscopy, in which an urologist inserts
ureteroscope trough the urethra, the bladder, and the ureter and the stone is
removed.